How to Prevent HIV Transmission

There was a time, not so long ago, when HIV prevention was driven by fear: fear of the unknown, fear of the damage that HIV can do, fear of people who are living with HIV.

For many HIV-negative folks, it felt like the only way to truly protect themselves from HIV was to avoid sex—or, heck, to avoid any contact at all—with people who are living with the virus. And many people with HIV felt the same way: better to avoid getting too close, and better not to even disclose your status, for fear of putting others at risk—and of being shunned, discriminated against, or even imprisoned just for being HIV positive.

Today, that stigma and discrimination is still going strong. But there’s no reason to fear people living with HIV, and there’s no need for people living with HIV to fear close contact with others.
Thanks to decades of extensive scientific research, we now have extremely reliable ways to prevent HIV transmission. People who are HIV negative have many tools they can use to stay negative, and people who are living with HIV also have several reliable ways to keep the virus from passing to others.

Today, HIV prevention isn’t driven by fear: It’s driven by the confidence of knowing each of us has the power to stop HIV transmission with us, whether we’re currently living with the virus or not.

Latesha Elopre, M.D.Assistant Professor

What Can HIV-Negative People Do to Reduce Their Risk of Becoming HIV Positive?

If you are HIV negative, there are several steps you can take to avoid becoming HIV positive:

Use condoms and dental dams.

Get tested and treated for sexually transmitted infections (STIs).

Use sterile equipment when you inject drugs.

Consider going on PrEP (pre-exposure prophylaxis).

Be aware of emergency PEP (post-exposure prophylaxis).

Know your risks.

Use Condoms and Dental Dams

Barrier methods, including condoms and dental dams, remain a tried-and-true method of preventing HIV transmission between sex partners, because they create a physical barrier that prevents the exchange of sexual fluid.

Plus, they have another added bonus: They prevent the transmission of chlamydia, gonorrhea, syphilis, and other STIs.

Get Tested and Treated for STIs

Untreated syphilis, chlamydia, and gonorrhea increase the likelihood that you will become HIV positive.

Thankfully, these infections can be treated and cured relatively quickly, but it’s important to get regularly tested and treated to reduce your risk of acquiring HIV.

Use Sterile Syringes

Injecting drugs raises your risk of HIV and other infections. If you inject drugs and you want to stop, there are resources available to help you.

Until then, it’s best to use sterile, unused needles and injection equipment. If you’re concerned you don’t have access to sterile equipment, there are usually resources available to help you find services in your community.

Consider Going on PrEP

PrEP, which stands for pre-exposure prophylaxis, is a prescription pill that can prevent HIV transmission if you take it regularly. It comes in two brand names - Truvada and Descovy - and has proven to be an excellent prevention method.

PrEP is prescribed by a health care provider; it’s generally prescribed as a once-daily medication, but there’s growing evidence that it can also be effective when taken according to a specific schedule right around the time you think you might be exposed to HIV.

PrEP does not prevent other STIs, so you will need to go back to the doctor every three months to get regular tests and check-ups.

PrEP can also be expensive if you don’t have coverage through private medical insurance or a public plan like Medicaid. If you have been prescribed PrEP but you cannot afford it, assistance may be available.

Be Aware of Emergency PEP

If you think you may have been exposed to HIV and you’re not taking PrEP, there is another way to protect yourself—but you need to act fast.

PEP stands for post-exposure prophylaxis. It is essentially a "morning after pill" for HIV.

If you had condomless sex, were sexually assaulted, or shared needles or syringes with someone who might have HIV, you can visit a health care provider, clinic, or the nearest emergency room and ask for PEP, and it should prevent the infection from spreading through your body.

The snag with PEP is that you need to start taking it within three days of the potential exposure for it to be effective. Once you start a course of PEP, you’ll continue taking it every day for one month.

Know Your Risks

We’ve covered the most important factors to know about HIV risk earlier in this article. Don’t forget that even if you have condomless sex with a person who’s living with HIV, you’re at no risk of becoming HIV positive if that person is on treatment and has an undetectable viral load.

This video on PEP and PrEP featuring David Malebranche, M.D., is part of the #AskTheHIVDoc series by Greater Than AIDS, a public outreach program run by the Kaiser Family Foundation.

What Can People Living With HIV Do to Reduce the Risk They Might Pass the Virus Along to Someone Else?

For people living with HIV, the most important thing you can do for your health is start taking anti-HIV medicines every day. Many people find that they will need to address other things first—like their mental health, housing, or insurance—and that’s OK. We’ve put together a guide to help newly diagnosed patients set themselves up for success.

Once you are ready and able to start treatment, it will make a big difference for your health. Studies show that people living with HIV who take their medicines regularly can live just as long as anyone else.

Anti-HIV treatment helps you live a long time because it blocks the virus from making copies of itself, which helps keep your immune system healthy. Most people who take their medication every day will see the levels of virus in their blood drop down to undetectable levels, meaning that laboratory tests can no longer detect virus at all.

If you are living with HIV, it is possible to live without fear of passing the virus to someone else. This is thanks to four major reasons, all fueled by decades of extensive scientific research:

Safe sex thanks to the concept of “undetectable equals untransmittable,” or U=U.

Condoms and other protection.

Safe injection practices.

Safe pregnancy options.

Safe Sex Thanks to U=U

In recent years, scientists learned that having an undetectable level of virus inside the blood means that HIV becomes untransmittable to sexual partners. That means HIV-positive people who take their medication and have an undetectable viral load will not pass HIV to their sex partners.

For many people living with HIV, the idea of U=U has helped them feel empowered to live healthy and active sex lives. Because U=U is relatively new, not a lot of people know about it, so don’t be afraid to shout it from the rooftops!

Of course, U=U will not protect you against other infections, so if you’re living with HIV and have an undetectable viral load, it’s still wise to use other forms of protection if your partner might have an STI. However, when it comes to HIV transmission, you should know that you cannot give someone HIV during sex if your viral load is undetectable.

Condoms and Other Barriers

Not everybody living with HIV has an undetectable viral load while on HIV medications. There are many reasons you may not be on treatment.

Perhaps you were just diagnosed; or you haven’t found a good care provider yet; or there are obstacles in your life (or with your health) that make it complicated to start treatment or consistently take your meds.

Or maybe you’re one of the relatively small number of people whose HIV treatment stops being able to fully keep the virus at bay, usually because of drug resistance.

Regardless of the reasons, if your viral load is not undetectable and you’re having sex, it’s worth considering other forms of prevention for you and your partner(s). Condoms and dental dams are two examples of barrier methods that help ensure you don’t pass HIV to your sex partners. Physical barrier protection will also help protect both you and your partner from the spread of STIs.

Safe Injection Practices

Rigorous studies on U=U have not yet been conducted among communities of people who inject drugs, but experts agree that having a low level of virus inside the blood will reduce the chance of an HIV-positive person passing the virus along to someone else.

Unlike with sexual transmission, an undetectable viral load may not completely eliminate the chance of HIV transmission among people who share needles. But if you are living with HIV and you inject drugs, you can definitely reduce the chances of passing the virus on by taking anti-HIV medication.

In addition, try to use sterile injection equipment every time you inject, and avoid sharing used equipment with others.

Safe Pregnancy Options

For pregnant people living with HIV, it’s important to seek regular prenatal care with a knowledgeable health care provider.

Newborn infants are particularly susceptible to HIV infection, which is why you may have to take extra precautions during and after your pregnancy.

Taking anti-HIV medicine to lower the level of virus in your blood to undetectable levels prevents HIV transmission almost 100% of the time.

Without taking anti-HIV medication, about 15% to 30% of infants will become HIV positive. After birth, infants are typically given anti-HIV medication for a short period of time to make doubly sure they won’t acquire HIV.

If you are HIV positive and you have recently given birth, your provider will likely recommend you use infant formula instead of breastfeeding your child, because there is a chance you could pass HIV along in breastmilk.

Also, you may want to avoid “pre-chewing” your infant’s food and feeding it to your baby. Although extremely rare, this has resulted in HIV transmission in three known cases in the United States. In at least two of those cases, blood was present in the parent’s saliva.

When Protecting Others, Protect Yourself, Too

One other thing to keep in mind: Most states in the United States have laws that require people with HIV to disclose their status before having sex or sharing needles.

Although the people who made these laws claimed they would help stop the spread of HIV, multiple studies have demonstrated that the laws have backfired: Not only have they done nothing to curb infection rates, they have only deepened HIV stigma, which makes it harder for people on the front lines of the fight against HIV to do their jobs.

Nevertheless, it’s important for you to know you may be at some legal risk if you decide not to tell a sex partner or injection partner about your status.

If all of this information is overwhelming, just remember one thing: Taking care of yourself is the best thing you can do to stop the spread of HIV. That means regular visits to your health care providers, attending to your mental and emotional health, and taking anti-HIV medication consistently.

Myles Helfand

Myles is the executive editor and general manager of TheBody/TheBodyPro. A career journalist and editor, Myles joined TheBody in 2001 as a part-time copyeditor. He has since established himself as a leading journalist and content strategist on HIV-related issues, authoring hundreds of articles and editing hundreds more -- and accumulating an ever-growing mountain of HIV conference badges along the way.